November 17, 2018

Being Mortal

Issue No. 394 of Your Weekly Staff Meeting recommends a MUST READ book on end-of-life issues that also oozes with leadership and management insights. The author notes, “People die only once!”And this reminder: click here to download free resources from the 20 management buckets (core competencies) and check out the links on these pages for my recent book reviews.

Pick One: Custer or Robert E. Lee

Apparently, I’m a slow learner.

You would think that when your daughter-in-law encourages you to read a book—you would read it. Ditto book recommendations from your wife.

Melinda and Joanne—sorry it took me a year to read this. But thank you. Because Being Mortal is now on my Top-10 book list for 2018.

In this riveting book, Dr. Atul Gawande reminds us: “People die only once.” So when facing fork-in-the-road sick and dying decisions, “They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and escape a warehouse oblivion that few really want.”

Being Mortal: Medicine and What Matters in the End changed—totally changed—my thoughts about end-of-life decisions. Whew. On one level, I agree that this New York Times bestseller (7,000 reviews on Amazon!) is a brilliant and deep look at the “…still unresolved argument about what the function of medicine really is—what, in other words, we should and should not be paying for doctors to do.” Yet on another surprising level, this writer (four bestsellers), surgeon, and public health leader—delivers fresh management and leadership insights in every chapter.

Custer or Robert E. Lee? The author says that medicine’s job is to fight death and disease—the enemy—but that the enemy eventually wins. “And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.”

Yet Gawande admits, “More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, ‘You let me know when you want to stop.’ All-out treatment, we tell the incurably ill, is a train you can get off at any time—just say when. But for most patients and their families we are asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve.”

By the way, watch for my review of Leaders: Myth and Reality, by General Stanley McChrystal (US Army, Retired), which includes a 30-page chapter on Robert E. Lee, and why this Civil War general’s picture no longer hangs in McChrystal’s office.

What should families do? My suggestion: ask your doctor (like I did this week) if he or she has read Being Mortal. (He had.) Gawande notes that medical school taught him two styles of doctor/patient interactions: paternalistic and informative.

The “paternalistic relationship”is the “priestly, doctor-knows-best model, and although often denounced it remains a common mode, especially with vulnerable patients—the frail, the poor, the elderly, and anyone else who tends to do what they’re told.”

Doctors make the critical choices. “If there were a red pill and a blue pill, we would tell you, ‘Take the red pill. It will be good for you.’ We might tell you about the blue pill; but then again, we might not.”

The “informative relationship” sounds good, at first. “’Here’s what the red pill does, and here’s what the blue pill does,’ we would say, ‘Which one do you want?’ It’s a retail relationship. The doctor is the technical expert. The patient is the consumer.”

The down side? Doctors become “ever more specialized” and “We know less and less about our patients but more and more about our science.” He writes, “In truth, neither type is quite what people desire. We want information and control, but we also want guidance.” In his medical school, there was also the brief mention of a third type of doctor-patient relationship often labeled “interpretive.”

“Here the doctor’s role is to help patients determine what they want. Interpretive doctors ask, ‘What is most important to you? What are your worries?’Then, when they know your answers, they tell you about the red pill and the blue pill and which one would most help you achieve your priorities.”

Makes sense right?Gawande notes that this relationship is also called “shared decision making” and added, “It seemed to us medical students a nice way to work with patients as physicians. But it seemed almost entirely theoretical. Certainly, to the larger medical community, the idea that most doctors would play this kind of role for patients seemed far-fetched at the time. (Surgeons? ‘Interpretive?’ Ha!)”

But two decades later, the author describes a meeting with his father (also a surgeon) and his father’s neurosurgeon. The task: review the MRI images of his father’s giant and deadly tumor. The neurosurgeon “saw himself as neither the commander nor a mere technician in the battle but instead as a kind of counselor and contractor on my father’s behalf. It was exactly what my father needed.”

To get the conversation going in your family, maybe insert a reminder into your Thanksgiving prayer next Thursday that everyone around the table will die only once! Then, mention this book as required reading for at least one family member. (“Grammy—please pass the turkey and that Being Mortal book.”)

Dr. Gawande is an amazing writer. The poignant stories are page-turners. The innovative solutions—inspiring and encouraging. I’ve already re-told many of the memorable fork-in-the-road stories (tears will flow) to friends and colleagues and ordered the book for several friends. Be sure to read the hilarious story of the very creative nursing home that added two dogs, four cats, and 100 parakeets! (Memo to Purchasing: Next time, order the cages before the birds are delivered!)

I should have jumped on this 2014 book much, much sooner—because I still rave about Gawande’s 2010 insightful bestseller, The Checklist Manifesto: How to Get Things Right (read my review).

I had no idea that there were checklist connoisseurs! The Checklist Manifesto moves eloquently through medicine, aeronautics, and sky-scraper construction—noting why checklists will make or break a venture. For example, Boeing’s checklist expert uses “pause points” when designing checklists for pilots in crisis. Within each pause point, he limits the checklist to between five and nine items.

As a staff writer for the New Yorker, Gawande’s latest article, “Why Doctors Hate Their Computers,” was published on Nov. 12, 2018. Click here to read or listen to the article online. (Customer Bucket Pop Quiz: Are computer systems for the doctors or for the patients?)

And—get this—Gawande is also CEO of the health care venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase to deliver better outcomes, satisfaction, and cost efficiency in care. Stay tuned!

YOUR WEEKLY STAFF MEETING QUESTIONS:1) What is your management style?How do you relate to your customers, clients, or donors? A) “Take the red pill—it will be good for you.” B) “There’s a red pill and a blue pill—you pick.” C) “We have some pills, but first, tell me what is most important to you?”2) Custer, Lee, or Jesus? Read 1 Corinthians 15:57 in The Message and then discuss the ultimate fork-in-the-road end-of-life issues. “…In the resurrection scheme of things, this has to happen: everything perishable taken off the shelves and replaced by the imperishable, this mortal replaced by the immortal.” Who will have the last word?

Speaking of medicine, if your marketing or fundraising is sick or dying, here’s a reminder from The Customer Bucket chapter in Mastering the Management Buckets. Leaders, managers, fundraisers, and marketing specialists must use the right tools for the right people at the right time. One size doesn’t fit all—so if you’re trying to shoehorn all of your messaging to all of your customers and prospects with just one message—you will fail or die.

If you need help moving customers from ignorance to purchase—contact Pearpod Media and they’ll help you craft the right message for the right audience within these six distinct levels of awareness: • Level 1: Ignorance • Level 2: Awareness • Level 3: Interest • Level 4: Trial or Consideration • Level 5: Preference • Level 6: Purchase

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